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Sue Arata

DARALEX/DARATUMUMAB PATIENTS

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Hello,

We are seeing an increase of patients on the new oncology drug for multiple myeloma (DARALEX/DARATUMUMAB) and I was wondering if anyone had any useful tips to share. Currently our procedure states to do a baseline ABSC prior to initiating the drug and to antigen type for at least Kell. Additionally, if the ABSC is positive in Gel, to rerun it in tube and to do an immediate spin crossmatch on Kell negative units (provided of course that the patient is Kell negative). Just wondering if this is how other places are handling these patients.

 Thanks,

Sue Arata

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Posted (edited)

If you have access to a maternity service, cord cells are negative for CD38, thus we use a homemade cord cell panel, which has been inexpensive and 100% successful in screening for clinically significant anti-red cell antibodies.  This drug is going to be used more frequently in initial treatment for multiple myeloma so one might as well be prepared for doing this very frequently in the future.  Fortunately these patients are not heavily transfused and only occasionally have alloantibodies.

Transfusion. 2015 Sep;55(9):2292-3. doi: 10.1111/trf.13174.

Alternatively, you can use DTT, see the above letter for references.

Daratumumab cord cell method.pdf

Edited by Neil Blumberg
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You should probably get used to the DTT procedure.  Hemo-BioScience offers the reagent in small aliquots that can be used easily without bothering with trying to manufacture the stuff.  There are several threads on this already on this site.  Do a search and see the discussions.   I had posted our procedure in one - let me know if it is not accessible now and I can send it to you.

The cord panel method would be nice if you are doing a lot of pts, and at least the cells will last a while.  DDT treated cells will not last long at all.  

 

 

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2 hours ago, Neil Blumberg said:

If you have access to a maternity service, cord cells are negative for CD38, thus we use a homemade cord cell panel, which has been inexpensive and 100% successful in screening for clinically significant anti-red cell antibodies.  This drug is going to be used more frequently in initial treatment for multiple myeloma so one might as well be prepared for doing this very frequently in the future.  Fortunately these patients are not heavily transfused and only occasionally have alloantibodies.

Transfusion. 2015 Sep;55(9):2292-3. doi: 10.1111/trf.13174.

Alternatively, you can use DTT, see the above letter for references.

Daratumumab cord cell method.pdf 46.52 kB · 2 downloads

Great Idea Neil, but again, this side of the pond, using cord blood for screening is a problem, because we have a law about using any body parts (including blood cells) without specific written permission from, in this case, the mother, following a court case when a hospital in Birmingham kept body parts from paediatric patients without parental permission (indeed, without telling them at all).  This has really made things VERY difficult for us.  These only (easily) leaves the option of DTT-treated red cells.

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You could antigen type the patient pre-Darzalex and transfuse phenotypically similar blood with a deviation form signed.  Or DDT treat and give least Incompatible K neg blood.  DDT destroys K.

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40 minutes ago, Patty said:

You could antigen type the patient pre-Darzalex and transfuse phenotypically similar blood with a deviation form signed.  Or DDT treat and give least Incompatible K neg blood.  DDT destroys K.

I think you will find that dichloro-diphenyl-trichloroethane will destroy a lot more than just the Kell Blood Group System antigens!!!!!!!!!!!  :angered::angered::angered::angered::angered:

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We will do a pre-darzelex blood type and antibody screen as well as antigen-type the patient for all antigens that we have anti-sera for.  When transfusion is needed after the darzelex is started, we will use phenotypically-matched packed cells.  If the patient specimens don't come until after the patient has received the drug, we send the specimens to our Red Cross Reference Lab buddies to work up for us.  They use the DTT (not DDT!) and antigen-type the patient to provide information for our future use.

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We are not phenotypically matching units unless the DTT treatment does not work or they have developed an antibody.

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On 5/24/2019 at 3:08 PM, Malcolm Needs said:

If your patient is Kell Negative (Ko) you have real problems.  If your patient is K Negative, you, and your patient, have more chance!

 

On 5/27/2019 at 1:16 PM, Malcolm Needs said:

If you use DDT, you won't last long either!!!!!!!!!!  SORRY, I couldn't resist it!!!!!!!!!!

 

On 5/28/2019 at 6:54 AM, Malcolm Needs said:

I think you will find that dichloro-diphenyl-trichloroethane will destroy a lot more than just the Kell Blood Group System antigens!!!!!!!!!!!  :angered::angered::angered::angered::angered:

:P

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We are doing pre-treatment antibody screens and sending out for full molecular typing.  We started this before we were doing DTT treatment in house.  We serologically K type them if we need to give blood before the molecular typing results are back. Now I am not so sure that the full typing is justified.  It seems to us that those who need transfusion whilst on the drug often don't stay on the drug long-term.  As mentioned above the majority of patients on it don't require transfusion.  I'm not going to change policies right away but am interested in others' experience.

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